To develop an effective
preventive programme against malnutrition, it is necessary not
only to assess the nature and magnitude of the problem but to
identify factors affecting it and their relative importance. The
nutritional status of an individual is the outcome of a complex
interaction of a broad range of host and environmental factors,
the latter encompassing physical, biological, and especially
socio-cultural ones. This study was conducted to examine the
relative impact of some of these factors, particularly those
socio-economic factors known to influence nutrition, as a means
of identifying the most important determinants of malnutrition in
rural Bangladesh. The decision to study only the effects of
socioeconomic factors on nutrient intake was dictated by the
consideration that the others can be readily manipulated to
improve nutritional status The factors included in the model were
per capita income, education, family size, female participation
in economic activities and time spent on food preparation, and
male participation in economic activities.

HYPOTHESIS

Income

Income is a mirror-image of a
household's resources and provides an index of its purchasing
capacity. Food that cannot be purchased is never consumed. The
economic situation is a potent factor in determining how much and
what kind of food will be available. It is, therefore, expected
that with the improvement of household income, absolute
expenditure on food is likely to go up, as is the calorie and
protein intake of the household [9].

Income is considered to be a very
important factor determining nutrition, at least in developing
countries. Examination of cross-sections of food consumption data
in these countries reveals highly significant differences based
on income class [12]. The World Bank also underscored the
importance of income as the critical determinant of nutrition in
developing countries. In 1980, the Bank maintained that the
serious and extensive nutritional deficiencies that exist in
almost all of these countries are "largely a reflection of
poverty, people don't have enough income for food" [24].

In view of these discussions, we
would expect to find a positive relationship between income and
dietary intake and dietary adequacy of a household. However, it
should be borne in mind that income is not always an exogenous
variable determining nutrient intake. It may also be an
endogenous variable; i.e. income may be determined by level of
nutrient intake. For example, one may note two types of
nutritional effects on productivity and hence income. These
effects are known as the "investment" and the
"energy" effects 122]. Inadequate nutrient intake in
gestation and the first few years of life may seriously impair
physical and mental development. Second, malnourished individuals
with a lower energy level will not be able to put enough effort
into current activities to raise their period income.

The effect of income is measured
here by expenditure on food, which truly reflects a household's
income and resources. One important reason for using per capita
expenditure on food instead of per capita income is the nonlinear
relationship between income and nutrient intake. The elasticity
of income with respect to food expenditure is usually less than
1, particularly for higher income groups. It has been shown
empirically that as income rises beyond a threshold level, people
tend to spend proportionately less on food than on non-food
items, particularly consumer durables. Although the proportion of
income spent on food declines, absolute expenditure on food is
still higher at upper income levels. Therefore it is posited
that, with the improvement of a household's income, absolute
expenditure on food is also likely to go up, and so is the
calorie and protein intake of the household.

Education

The relationship between parental
education and the dietary intake of a household is complicated.
On the one hand, greater education is associated with greater
awareness of the importance of nutrition, the nutrient content of
food, and nutrition options from market purchases or from home
production. Better-educated parents should be able to provide
more nutritious diets at any income level due to their ability to
identify the nutrition values of food. Thus, when education
represents efficiency in household production, the elasticity of
nutrition with respect to education is likely to be positive. On
the other hand, education is also a measure of taste. Higher
education may also increase the desire to consume status food and
non-food items to the detriment of nutrition. If education
represents taste, the elasticity of nutrition with respect to
education may be positive or negative.

It may be noted further that the
effect of education on nutrient intake is likely to be more
positive for female than male education, for the following
reasons. Female education leads to efficiency in the allocation
of food consumption and also, possibly, to an awareness of the
importance of nutrition and less regard for status consumption.
The positive effect of male education on nutrition is mostly due
to the association with expenditure. Education is associated with
lower prices paid for by the household, perhaps because marketing
ability is enhanced. The ability to identify the nutrition values
of foods allows a given expenditure on foods to yield more
nutrients.

Family/Household Size

Increased family size may
adversely affect the nutritional status of every member of the
household because it may be associated with decreased per capita
human input. That is, the allocation of food per member is likely
to decrease with the increase in the number of household members,
which, in turn, may have a negative affect on per capita nutrient
intake. Increased household size also implies acceptance of fewer
resources in a quality/quantity model of fertility decision.

In some situations, however, as
in Bangladesh, family size may itself indicate higher economic
status. In this case, larger families may not lead to a reduced
nutrient intake by members of the household. One may also note
economies of scale in nutrition because of less waste and the
possibility of purchasing in bulk associated with larger family
size. (One result that does show up frequently in expenditure
surveys is that the amount of food purchased rises less than
proportionately to household size when per capita income is held
constant. This may be considered as an indication of somewhat
behavioural economy of scale in food use.) It should be pointed
out further that it is not family size per se but the number of
adults relative to children that is the crucial factor
influencing the intake of members of a household. The lower the
dependency ratio, the higher the nutrient intake of the household
members.

Female Participation in Economic Activities and Time Spent
on Food Preparation/Cooking

The relationship between female
participation in market activities and nutrient intake on one
hand and female involvement in home production and nutrient
intake on the other are likely to be contradictory. The former is
expected to be negative, while the latter will be positive. It
has been often hypothesized that women's participation in market
activities will be detrimental to the health and nutrition status
of the household, owing to the loss of home food production. Data
from rural areas of Laguna province, Philippines [8], clearly
indicated the negative effect of the mother's market activities
on the overall nutritional status of a household.

However, greater involvement by
women in home production is likely to be positively associated
with the nutritional adequacy of a household, for three reasons:
(i) women spend their time purchasing items rather than using
home time to produce them; (ii) a woman working outside the home
may resort to non-nutritive convenience foods to the detriment of
the health of the family members; (iii) money does not always
meet nutritional needs. Even with the same amount of money for
food, some families are able to meet their nutritional needs,
others exceed theirs, while yet others fail. These variations
depend, among other things, on the time used in preparing food
and housewives' knowledge and skills. In turn, knowledge and
skills determine, to a large extent, how much money and time are
needed and how well they are used.

We have so far discussed the ways
in which withdrawal of women from home production to market
activities may adversely affect the nutritional status of a
household. However, this is only one side of the picture.
Increasing female involvement in home production does not
necessarily improve the nutritional status of the household.
There is a point beyond which the degree of increase in dietary
quality is reduced as more time is spent on food preparation. It
is a fact that heat-labile nutrients are lost the longer some
foods are cooked. Similarly, the effect of female participation
in market activities on a household's nutrient adequacy is not
necessarily negative, and may, in fact, be positive.

Employment outside the home
provides women with alternative satisfactions to children, such
as companionship, recreation, stimulation, creative ability, and
social and economic rewards, which may well compete with raising
children and may lead to lower fertility [2] . The lower
fertility of a working woman will increase the availability of
food grains per child, which may lead to the better nutritional
status of a household.

Moreover, working women add
substantially to the family income [3] and, in contrast to
working men, spend a higher proportion of their income on food,
while men spend on nonfood stuffs [10]. This could also improve
the nutritional status of a household. In this study, we tried
partially to control this conflicting effect of mother's work on
the dietary adequacy of a household by adjusting for important
related variables, such as income and number of children.

Male Participation in Economic
Activities

The relationship between number
of hours worked in productive activities and nutrient adequacy of
a household is somewhat complex. In a subsistence economy such as
that in Bangladesh, family labour, particularly male labour, is
important in determining the economic condition of a household.
The higher the participation in productive activities, the higher
the income of a household, which in turn is likely to increase
the nutrient intake of the household. However, work pattern also
affects food consumption directly. Increased number of hours
worked increases work-calorie requirements, and the poor in
Bangladesh tend to work longer hours than the rich [2] .
Therefore, in spite of working longer hours, the poor may not be
able to meet their nutrient requirements, even though their
incomes are raised marginally. This is because the increased
income is not sufficient to offset the increased work-calorie
requirement.

MATERIALS AND METHODS

The data employed in this study
were collected from 572 members of 108 households in the village
of Muyiarchar, approximately 220 miles north-east of Dhaka, in
Sylhet district. The sample included 50 per cent of the village
households selected from various socio-economic groups,
classified on the basis of land holding and income. Households
were selected from each socio-economic stratum, with a
probability equal to their proportion in each group.

The present analysis is based on
full 572 members of 108 households in the sample. The data
collected included consumption of rice, wheat, fish, milk, meat,
pulse, eggs, vegetables, and fruits per person per day, and the
sources and costs of food consumed. Together with data on food
consumption, we also obtained information on time allocation for
every member of the household five years of age or older. This
helped in estimating nutritional requirements, based on the type
of activities in which the individuals were engaged, together
with other considerations.

The data on food consumption were
collected from each member of the household (mothers provided the
information about children) once a month and those on time
allocation twice a month (i.e. every 15 days) over a period of
one year (August 1978 to July 1979) by 24-hour recall interview.
Time budgets were collected from each eligible respondent of the
household in the form of a sequential record of a respondent's
activities and their duration for the 24-hour period preceding
the interview. Interviewers were locally recruited and were
mostly teachers from a nearby elementary school.

Individual food intake was
converted into nutrient (calories and protein) intake by
employing Indian food composition tables [9] . Average calorie
requirements and safe levels of protein intake were estimated for
every member of each household to assess whether a person
consumed more or less than, or an amount equal to, the average
requirement. Nutrient needs were estimated in two phases. In the
first we determined the calorie and protein needs of children
from birth to age four years, according to the age- and
sex-specific recommendations of the joint FAO/WHO/UNU
consultation [6]. These recommendations were adopted both to
allow for the full potential growth of a child and to provide
extra calories and protein to compensate for losses caused by
infectious and parasitic diseases widely prevalent in rural
Bangladesh. In the second phase we estimated the nutrient
requirements for the remaining members of the household, those
five years of age and older. These estimates were based on the
same recommendations [6] .

The estimation of calorie
requirements of persons of five years and above were based on
actual information on their rest/sleep and physical activity.
This is because human energy requirements consist of two major
components: basic energy demands for resting metabolic function
and all other energy costs, mainly physical activity.

To arrive at an estimation of
caloric need for physical activities and rest/sleep, physical
activities were grouped into three categories, light, moderate,
and heavy, on the basis of actual time in minutes for each of
these activities per day per person. We then calculated the
energy required per person per day for each of these kinds of
activities for males and females separately, as per
recommendations of the FAO/WHO/UNU joint report [6] . To this was
added the energy needed for sleep/rest (basal metabolic rate) per
person per minute, estimated on the basis of the individual's
actual weight.

A final adjustment was made to
allow sufficient energy for pregnancy and lactation; the extra
allowance was 285 calories per day for a pregnant woman. In
Bangladesh, breast-feeding commonly extends beyond the second
year of life and may continue as long as four years [4]. On the
basis of actual milk production of lactating mothers ob- from
rural areas of Bangladesh, we added 500 calories for mothers with
children two years old or younger.

The safe allowance for protein
for a person age five years and above was made on the basis of
FAO/WHO/UNU recommendations [6] . This was calculated by
multiplying the average safe protein allowance per kilogram of
body weight in a particular age/sex group by the average weight
in kilograms of a person in the corresponding age/sex group. In
addition to this, allowance was made for pregnancy and lactation,
a pregnant women being allotted 5.6 g of protein. We added 17 g
of protein (per day per person) for mothers with children one
year old or younger and 11 g for mothers with children between
the ages of one and two years. All protein estimates were
corrected for 70 per cent utilization.

Dependent Variable

The major dependent variable used
in this study was the mean nutrient adequacy ratio (NAR) of a
household. This is the ratio of the total nutrient intake of a
household divided by its total nutrient requirement, times 100.
This ratio is derived by summing the calorie and protein intake
and nutrient need (i.e. recommended daily allowance of calorie
and protein) for every member of the household separately, and
then dividing the total of the former (i.e. intake) by the latter
(i.e. need) times 100. The mean nutrient adequacy ratio measures
whether a household is consuming more or less than, or the
equivalent of, its need.

Overall Nutrition Situation of the Study Village

According to our measurement of
nutrient adequacy, 40 per cent of the households in the study
village failed to meet calorie requirements. This is an overall
percentage only, and conceals variations in nutrient adequacy
among households. For example, if the nutrient adequacy of a
household is examined by its level of income utilizing data of
the present study, 100 per cent of the households with a per
capita monthly income of less than or equal to 148 take fail to
meet the calorie requirement. The corresponding figure among
households with a per capita monthly income of 149 to 225 take is
54 per cent. These two income groups acounted for 45 per cent of
the households in the study village. However, 95 per cent of the
households appeared to meet their protein requirements, though in
reality the situation may be different. We mentioned earlier that
40 per cent of the households could not meet their calorie
requirements, and these households may, for all practical
purposes, be considered deficient in protein intake. Inadequate
energy intake reduces the utilization of protein added to the
diet.

The average calorie and protein
intake per day per person in the study village was 1,829 kcal and
58 9. Compared to the national level, the average calorie intake
was slightly lower, while protein intake was almost the same.
According to the nutrition survey of 1981/1982 [18], the average
calorie and protein intake per day per person was 1,943 kcal and
48.4 g respectively. Cereals, particularly rice, were the
dominant source of calories and protein, with rice accounting for
82 and 53 per cent of calorie and protein intake respectively.
This finding was corroborated by other nutrition studies in
Bangladesh [16-18] .

Fish and meat were the second
important sources of protein in the village, accounting for 30
per cent of total protein intake; the other noteworthy sources
were pulses and wheat. Fish, meat, and wheat contributed 10 per
cent of total calorie intake. These findings, showing the
overwhelming dominance of cereal over animal sources, clearly
reflect an imbalance in the diet of rural households

Determinants of Nutrient Adequacy: Estimates of the Basic
Model for Household Demand for Nutritional Inputs

We have so far discussed the
overall nutritional situation of the study village. We now
examine the socio-economic and demographic factors, as posited
earlier, affecting the nutrient adequacy of a household.
Multiple-regression analysis was employed to measure the net
effect of each of the variables in the model on dietary adequacy,
and in this case could be expected to identify the effects of
each of the contributory variables in the equation, that is,
holding other factors constant. The functional form of the
relationships is expressed in the following equation:

The reasons for employing simple
linear functions for these estimates over other complicated
functions are as follows: (i) the implied specification of the
underlying preference function could be arbitrary; (ii) the data
employed here, although significant in many respects, may not be
precise enough to permit discrimination with much confidence
among higher properties of functional forms; and (iii) ordinary
least-squares (OLS) estimation methods stand up against
specification errors better than most simultaneous methods [13] .

Multiple regression is not per se
a technique for policy selection but rather a useful means of
providing insights to facilitate and improve upon such selection.
It provides important guidance toward relative selection of
policy instruments.